Healthcare spending will account for 20% of US gross domestic product by 2028. One strategy to address rising costs is evaluating the utilization fraction (UF) of surgical trays. Utilization fraction ...averages between 13% and 27% among surgical specialties, yet data from plastic surgery are lacking.
This prospective observational study assessed UF of surgical instruments in all reduction mammoplasty performed at 2 sites in the same healthcare system over a 6-month period. Site 1 is a tertiary hospital and site 2, an outpatient surgical center. Utilization fraction was calculated as percent fraction of used, or if operating surgeons touched them, to opened instruments. A new surgical tray was created by removing instruments not used in 20% of cases. Reprocessing costs and savings were calculated using published reprocessing figures of $0.10 to $0.51 per instrument. Descriptive statistics and parametric variables reported as mean ± standard deviation. Unpaired Student t test was performed to determine statistical significance of findings ( P < 0.05).
Four plastic surgeons performed 37 procedures, 11 at site 1 and 26 at site 2. At site 1, 112 instruments are opened in one tray with 53 unique and 59 duplicates. At site 2, 155 instruments are opened in 2 trays with 58 unique, 20 shared, and 77 duplicates. Instrument user did not vary by site ( P = 0.446), with 19 ± 3 instruments and 17 ± 3 instruments used per case; however, UF varied significantly ( P < 0.0001) with average UF of 16.6% ± 2.8% and 11.5% ± 1.7% at sites 1 and 2, respectively. Estimated reprocessing costs per case are currently $11.20 to $57.12 at site 1 and $15.50 to $79.05 at site 2, with unused instruments accounting for $9.34 to 47.64 and $13.72 to $69.96, respectively. The new surgical tray includes 32 instruments, 18 unique and 14 duplicates, with estimated reprocessing cost of $3.20 to $16.32 per case. Adoption would reduce reprocessing costs by approximately $8.00 to $40.80 and $12.30 to $62.73 per case at sites 1 and 2, respectively.
Despite studying a single, but common, plastic surgery procedure, our findings reveal consistency in excessive appropriation of instruments between sites with values similar to those in the literature. These findings exemplify a cost-saving opportunity at our institution and chance to optimize UF for other high-volume plastic surgery procedures.
After decades of lean principles implementation in manufacturing companies, there is no debate about its benefits on waste elimination and efficiency improvement. Service organizations, a growing ...stake of the global economy, are committed to achieve such improvements. Considering current economic scenario, marked by budget cuts and cost reduction, outstanding results are expected from the application of lean manufacturing into service management. However, results may not be as expected when trying to apply technical tools, developed for industrial processes, to intangible products. This paper intends to redefine value and waste concepts, focused on the inherent characteristics of service: intangibility, perishability, inseparability, variability and lack of ownership. Based on this approach, an analysis of customer value and customer life cycle (end-to-end process) is performed. Finally, lean methodologies are assessed in order to extend their applicability to service environment. These results can be useful to provide a practical guideline to implement lean service.
One of the challenges facing operations management is the design, choice, and implementation of action plans adapted to the magnitude of the deviations from the variables of an industrial process. ...Making conscious and quick decisions is crucial to achieving improvements in productivity. This will be achieved if the organization’s internal and external communication model is strategically designed, considering specific cultural factors and the symmetry or asymmetry required in the communication model. However, how do we organize ourselves and through what channels do we communicate within a production process to generate Big Data that combines data from technologies and the perception, comprehension, and projection of experienced humans? Our hypothesis suggests that the implementation of our model generates a continuous improvement system that could provide significant benefits to the company by connecting management with the place where the work happens (Gemba), streamlining multiple processes, thereby fostering sustainability. The developed model, “Group Situational Awareness Model”, was implemented in an operations management team, following the guidelines of an action researcher methodology. This resulted in the design of an operations management model and a detailed methodology for its implementation, achieving significant improvements in the metrics of the current process, making it a success story.
Lean is one type of organizational change and improvement methods by cost reduction mechanism. The assumption is, by reducing costs, the organizations can work better and more efficiently. All ...changes in lean-based organizations are directed at reducing these costs by identifying and eliminating waste. The thinking is that cost reduction will increase efficiency since basically, cost reduction occurs due to the loss of process inefficiencies and decreases of cycle time. Why are targets directed at cost reduction? Because costs are a crucial factor for sustainable business organization. Lean thinking cuts the value of scale production by looking at the existing waste in a process. Production remains the same, but the costs of goods production is reduced due to the elimination of waste in the process. As a result, companies do not have to increase their production if it is not required, giving companies an increase in average profits due to lean and the elimination of identified waste. This becomes the second part of the fourth definition which focuses on cost reduction. the focus on cost reduction can be included in the overall lean concept since cost wasting is only a part of the existing waste. Actually, other wastes can be converted into costs or in other words, perceived by the money value. This book starts the mental process of organization change through Lean thinking. It provides the background and history of lean and moves to how the lean process works. The author also discusses why an organization should implement lean as a method to increase quality and engage workers in the process thereby increasing efficiency and ultimately profitability. Through case studies and examples from Indonesia, the author describes how to create a value stream to identify waste and discusses the concept of a pull system and its impact on the process.
An improvement team from the Complex Care Center at our large pediatric medical center participated in a 60-day initiative to use Lean methodologies to standardize their processes, eliminate waste ...and improve the timely and reliable provision of durable medical equipment and supplies.
The team used value stream mapping to identify processes needing improvement. Improvement activities addressed the initial processing of a request, provider signature on the form, returning the form to the sender, and uploading the completed documents to the electronic medical record. Data on lead time (time between receiving a request and sending the completed request to the Health Information Management department) and process time (amount of time the staff worked on the request) were collected via manual pre- and post-time studies.
Following implementation of interventions, the median lead time for processing durable medical equipment and supply requests decreased from 50 days to 3 days (p < 0.0001). Median processing time decreased from 14min to 9min (p < 0.0001). The decrease in processing time realized annual cost savings of approximately $11,000.
Collaborative leadership and multidisciplinary training in Lean methods allowed the CCC staff to incorporate common sense, standardize practices, and adapt their work environment to improve the timely and reliable provision of equipment and supplies that are essential for their patients.
The application of Lean methodologies to processing requests for DME and supplies could also result in a natural spread to other paperwork and requests, thus avoiding delays and potential risk for clinical instability or deterioration.
Recognizing the significant impact of wait times for care for individuals with complex chronic conditions, we applied a LEAN methodology, namely - an adaptation of Value Stream Mapping (VSM) to meet ...the needs of people with multiple chronic conditions and to improve wait times without additional resources or funding.
Over an 18-month time period, staff applied a patient-centric approach that included LEAN methodology of VSM to improve wait times to care. Our framework of evaluation was grounded in the needs and perspectives of patients and individuals waiting to receive care. Patient centric views were obtained through surveys such as Patient Assessment of Chronic Illness Care (PACIC) and process engineering based questions. In addition, LEAN methodology, VSM was added to identify non-value added processes contributing to wait times.
The care team successfully reduced wait times to 2 months in 2014 with no wait times for care anticipated in 2015. Increased patient engagement and satisfaction are also outcomes of this innovative initiative. In addition, successful transformations and implementation have resulted in resource efficiencies without increase in costs. Patients have shown significant improvements in functional health following Integrated Chronic Care Service (ICCS) intervention. The methodology will be applied to other chronic disease management areas in Capital Health and the province.
Wait times to care in the management of multimoribidities and other complex conditions can add a significant burden not only on the affected individuals but also on the healthcare system. In this study, a novel and modified LEAN methodology has been applied to embed the voice of the patient in care delivery processes and to reduce wait times to care in the management of complex chronic conditions.
The way forward for fast microbiology Mulatero, F.; Bonnardel, V.; Micolaud, C.
Clinical microbiology and infection,
20/May , Letnik:
17, Številka:
5
Journal Article
Recenzirano
Odprti dostop
In microbiology, successful automation means ‘fast microbiology’. As Thierry Bernard, bioMérieux’s Corporate Vice President of Commercial Operations, put it, ‘Bugs mutate very quickly, so we have to ...innovate continuously to keep up with them … As we are faced with new pathogens, microbiologists must work side‐by‐side to find solutions.’ Fast microbiology is based on a premise of faster results; reducing the time needed for a result, to allow earlier and optimized patient management. Obviously, the critical component for success is the expertise of the microbiologist at every step, validating new solutions, databases, and algorithms. Although the way in which microbiological testing is performed may change, the essence—individualized/expert interpretation of test results and the proposal of targeted treatments by the microbiologist—will remain.
Disconnects and defects in care - such as duplication, poor integration between services or avoidable adverse events - are costly to the health system and potentially harmful to patients and ...families. For patients living with multiple chronic conditions, such disconnects can be particularly detrimental. Lean is an approach to optimizing value by reducing waste (eg, duplication and defects) and containing costs (eg, improving integration of services) as well as focusing on what matters to patients. Lean works particularly well to optimize existing processes and services. However, as the burden of chronic illness and frailty overtake episodic care needs, health systems require far greater complex, adaptive change. Such change ought to take into account outcomes in population health in addition to care experiences and costs (together, comprising the Triple Aim); and involve patients and families in co-designing new models of care that better address complex, longer-term health needs.
The skin tumour unit at one London hospital has been providing extracorporeal photopheresis (ECP) treatment since 2012, using an online fully integrated system. This report summarises 9 years of ...continuous process improvement, which has enabled the team to meet the growing demand for ECP treatments for cutaneous T-cell lymphoma (CTCL) and graft-versus-host disease (GvHD) patients. The unit formed a partnership with a lean-management company to go through the process of evaluation of capacity constraints, design layout and patient scheduling. Methods: Increased capacity year-on-year and over the 9-year period was calculated based on data collected from records. The authors reviewed the nurse staffing resources allocated for ECP treatments over the same period, and financial value created by the continuous improvement (additional number of treatments multiplied by the national tariff for ECP treatments). Results: In 2012 the average number of ECP treatments per nurse per week was 11. With the implementation of the new planning tool, and improved working practices, the average number of treatments per nurse per week has more than doubled to 23. Nurse staffing was maintained at 4 nurses per shift to deliver ECP treatments. The unit recorded additional revenue of approximately £3.2 million in 2020 compared with 2012. Conclusions: The team has successfully increased the capacity of the service to deliver treatments without incurring any additional nursing costs, resulting in more patients with CTCL and GvHD being able to access ECP treatment and a cost benefit for the Trust. The service continues in its mission to grow and provide a superior patient experience.
Purpose: The Lean methodology was applied to clinical metrics by a critical care pharmacy team. The experiences associated with the development and implementation of clinical metrics and their impact ...on daily workflow are described.
Summary: The Lean methodology has been introduced into the healthcare system as a means of process improvement, which can eliminate waste through appropriate medication utilization. At OhioHealth Riverside Methodist Hospital, the department of pharmacy was tasked with the development of clinical metrics after a health system wide Gemba walk was initiated. The pharmacy department's critical care team developed a strategy identifying and evaluating clinical metrics pertaining to their everyday workflow. Each clinical metric was evaluated in accordance with a pre-defined goal. Metrics requiring heavy documentation and those in which the pharmacist does not have autonomous authority to manage were often challenging to implement and were less successful. Throughout this process, the lessons learned focused on generating ideas that were easily documented, evidence-based, and department specific. The critical care team discovered that the outcome of the most successful metrics highlighted clinical pharmacist value and data generated could be used to support funding for additional resources.
Conclusion: The critical care pharmacy team developed a streamlined process to implement clinical metrics as means of identifying areas for improvement using the Lean methodology.
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